Nightingale Hospital

Updated 7 November 2024

Nightingale Hospital is an independent hospital that provides mental health care and treatment for people who may or may not be detained under the Mental Health Act 1983. The service provides 4 acute wards for adults of working age, 1 obsessive compulsive disorder ward, 1 substance misuse and detoxification ward, and 1 specialist eating disorder service for adults. The eating disorder ward is located in a separate nine-bedded three-storey building. Bendall Mews eating disorder unit provides eating disorder services for individuals aged 18 and above. Treatment can be accessed as part of an outpatient, day patient or inpatient programme. We carried out our on-site assessment of the service on 17 April and 13 June 2024. We carried out this assessment to check on compliance with requirements from the previous inspection in June 2022 and in response to feedback about the service received by CQC. At the previous inspection the eating disorder service was rated Requires Improvement in all key questions except Responsive which was rated Good, leading to an overall rating of Requires Improvement. As part of the assessment we spoke with 8 patients, 4 relatives/carers of patients, and an independent advocate who attend the service. We spoke with 11 staff members including the consultant psychiatrist, ward manager, dietitian, psychotherapist, and psychologist, 2 registered nurses, a student nurse, 3 non-registered nurses, and looked at 7 patients’ care records, 3 patients medication records, checked the clinic room and unit environment, and attended a staff handover meeting between shifts. We looked at health and safety records of the service and a selection of staff recruitment records, and training supervision and appraisal records. Overall, we found that patients felt safe in the service, and most relatives of people using the service were positive about staff care and treatment. However, some raised concerns about incidents that had occurred on or off the hospital premises. The environment was clean, and well maintained. Patients said that staff were readily available and generally supported them with kindness. However, they raised concerns about the number of bank or agency staff that worked with them, some of whom did not always support them sensitively. The ward manager was working to address these concerns about bank and agency staff, providing them with improved inductions and training. Patients were involved in producing their care plans and completed their own daily risk assessments alongside staff members. They were supported with medicines appropriately and provided with relevant information about their treatment. Patients said that staff helped them to prepare for stepping down to being day patients with appropriate advice and consideration of risks that they would face. They were positive about the range of psychological interventions available to them, describing staff as kind, empathetic, and going the extra mile to support them. As required at the previous inspection in June 2022, there had been an improvement in the governance systems and processes within the hospital. Management of the clinic room and medicines management had improved, a new and more appropriate chair was provided for nasogastric feeding. Staff were using a recognised risk assessment to ensure patients’ skin integrity. Managers had taken steps to improve consistency of staff compassion and empathy, although this was still an area to be addressed with the use of bank and agency staff. Patients and carers felt that the hospital looked into their complaints and made changes accordingly. However, prior to the inspection, a small number of patients and carers were unhappy with how responsive the service was to their concerns. Staff described a recent difficult period on the ward when many patients had significant needs, and they had struggled to manage their care effectively. They said that senior managers had stepped in to suport them.

Updated 21 August 2024

Nightingale Hospital is an independent hospital that provides mental health care and treatment for people who may or may not be detained under the Mental Health Act 1983. The hospital offers general psychiatry, eating disorders, obsessive compulsive disorder and addiction treatment for adults as both inpatients and outpatients. The service provides 3 acute wards for adults of working age, an obsessive compulsive disorder ward, a substance misuse and detoxification ward, and a specialist eating disorder service for adults. The eating disorder ward is located in a separate 9-bedded 3-storey building. Bendall Mews eating disorder unit provides eating disorder services for individuals aged 18 and above. Treatment can be accessed as part of an outpatient, day patient or inpatient programme. We carried out our on-site assessment of the service on 17 April and 13 June 2024 to check on compliance with requirements from the previous inspection in June 2022 and in response to feedback about the service received by CQC. At the previous inspection the eating disorder service was rated Requires Improvement in all key questions except Responsive which was rated Good, leading to an overall rating of Requires Improvement. Overall, we found significant improvements at the service. Patients felt safe in the service, and most relatives of people using the service were positive about staff care and treatment. The environment was clean, and well maintained. Patients said that staff were readily available and generally supported them with kindness. However, they raised concerns about the number and skills of bank or agency staff that worked with them. The ward manager was working to address these concerns. Patients were involved in producing their care plans and completed their own daily risk assessments alongside staff members. There had been an improvement in the governance systems and processes within the hospital following an unsettled period on the ward.

Updated 10 October 2022

The substance misuse service a 28-day treatment programme or a detoxification programme. The therapy programme followed the 12 step programme, a widely used and recognised psychosocial treatment programme for people with addictions.

Updated 13 May 2019

The hospital had taken action to address areas highlighted as a concern in the last inspection in January 2018. This included taking steps to address environmental risks, with significant work undertaken to reduce ligature risk areas on each ward, personal alarms provided to staff, improved infection control protocols, and addressing actions from the hospital’s fire safety assessment.

The provider put in place systems to ensure that staff were made aware of lessons learned from incidents, and staff had regular supervision and appraisals.

Staff had received training in interventions to protect patients from harm, including the provision and use of naloxone, and action to take in the event of an alcohol withdrawal seizure. Staff understood how to use the validated tools for patients undergoing detoxification from prescribed drugs and alcohol. There were also improved protocols for ensuring that patients undergoing detoxification were protected from harm, including better physical health monitoring.

Improvements were made to the prescription, storage and administration of medicines.

There was an improvement in recording patients’ involvement in the development of their care plans.

However:

Staff did not have access to the results of recent audits on the wards, and there were no regular checks of mattresses and soft furnishings on the wards to ensure good standards of infection prevention and control.

Nursing competencies for the addiction unit staff were not specific to the care of patients with substance misuse issues.

Staff meetings were not always held on a regular basis or include standard agenda items related to quality and safety. Staff were not always able to access a clear record of the minutes of the last meeting.

Updated 10 October 2022

The acute wards provided mixed sex accommodation, apart from two acute wards on the first and second floors, that are single sex. The ground floor ward was a mixed sex 11 bed acute ward for adults of working age. The first floor had two wards: a 14 bed male acute ward and a six-bed obsessive compulsive ward for adults of working age. The second floor was a 17 bed female only acute ward for adults of working age.